Provider Demographics
NPI:1649265463
Name:DOOLABH, VAISHALI B (MD)
Entity type:Individual
Prefix:
First Name:VAISHALI
Middle Name:B
Last Name:DOOLABH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3948 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7035 SOUTHPOINT PKWY S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8709
Practice Address - Country:US
Practice Address - Phone:904-854-4800
Practice Address - Fax:904-854-4801
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2024-05-21
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FLME82927208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG89556Medicare UPIN
FL01910Medicare ID - Type Unspecified